Health-system preparedness for early detection of mild cognitive impairment: primary-care evidence from a national study among general practitioners in Romania

Abstract

Mild cognitive impairment (MCI) is a growing public health concern in aging populations. In Romania, adults aged 65 years and over comprise about one fifth of the population, and estimated MCI prevalence in this age group is among the highest in Europe (28.5%), yet no organised national programme for systematic early detection exists. General practitioners (GPs) are well positioned to contribute to population-level detection, but their knowledge, attitudes and practices regarding MCI have not been evaluated nationally. This study assessed these domains as primary-care indicators of health-system preparedness for early MCI detection. We conducted a national cross-sectional study among GPs practicing in Romania between June 2025 and January 2026, using an online self-administered questionnaire adapted from a published knowledge, attitudes and practices instrument. Analyses included descriptive statistics, Spearman correlations, group comparisons and multiple linear regression. A total of 547 eligible GPs were included; 365–416 completed the questionnaire sections. The mean knowledge score was 33.20 (SD = 16.37): only 6.5% identified the Petersen diagnostic criteria, 10.8% recognized the most used cognitive screening instrument and 20.7% identified modifiable risk factors. Attitudes towards MCI detection were favorable (mean = 73.26, SD = 6.96). Nearly all GPs (97.9%) agreed that they should be involved in MCI detection, while 91.4% believed that early detection may delay progression to Alzheimer’s disease. Reported practices were more variable (mean = 73.01, SD = 11.53), and only 29.0% routinely used screening tools. Regression models explained a modest proportion of variance in reported practice. Higher practice scores were associated with more favorable attitudes, greater knowledge, MCI-specific training, and higher daily patient volume, whereas larger registered patient lists were associated with lower practice scores. Only 10.8% had received MCI-specific training. Romanian GPs strongly support early MCI detection, but this willingness coexists with knowledge gaps, limited screening use, scarce training and workload constraints. In a high-prevalence aging population without an organised national programme, these findings indicate a public health gap between population need and health-system preparedness. Strengthening early detection is likely to require targeted continuing medical education, feasible screening recommendations and organizational support for structured cognitive assessment.